Patients with TKA Who Receive Outpatient Physical Therapy Soon After Surgery Recover More Quickly Than Patients Who Receive Home Physical Therapy First

This was published Monday, January 23, 20017 by PT in Motion News

In brief:

  • Retrospective cohort study focused on 109 TKA patients
  • One group (87) received outpatient physical therapy beginning within a week of discharge; a second group (22) received 2-3 weeks of home physical therapy before entering an outpatient physical therapy program
  • While 6MWT and KOOS outcomes were the same for both groups at completion of outpatient physical therapy, the home health group took average of 20 days longer to reach benchmarks
  • Authors believe results point to need for patient education and choice; potential cost savings of immediate outpatient physical therapy

A new study finds that when it comes to results, patients who undergo total knee arthroplasty (TKA) and engage in home physical therapy before participating in outpatient physical therapy ultimately wind up doing just about as well as patients who proceed directly to physical therapy sessions. The time it takes them to reach those outcomes, however, is another story.

Writing in a recent issue of Orthopedic Nursing (abstract only available for free), researchers report on the results from an analysis of 109 TKA patients who participated in a hospital’s joint replacement program, and who had the option of entering into outpatient physical therapy beginning within a week after surgery (87 individuals, called the OP group) or receiving home health care for 2 to 3 weeks before moving on to outpatient physical therapy (22 individuals, labeled the HH group). Researchers reviewed medical records from 2005 to 2010 to find out if the 2 paths resulted in different outcomes and what those outcomes were after completion of outpatient physical therapy.

Researchers found that in terms of outcomes as measured by the 6-minute walk test (6MWT) and the Knee Injury Osteoarthritis Outcome Score (KOOS), both groups ultimately achieved similar scores (adjusted for age and other variables). Patients averaged nearly 80% of age and sex-predicted distances on the 6MWT and registered KOOS subscale scores (activities of daily living, pain, symptoms, and quality-of-life) that didn’t vary significantly between groups.

When they looked at the time it took for patients to reach those outcomes, however, the researchers found that patients in the OP group reached postoperative milestones about 20 days sooner, on average, than their HH counterparts. Additionally, both groups averaged about the same number of outpatient physical therapy sessions, “pointing to the fact that home health [physical therapy] did not accelerate recovery (with the possible exception of knee flexion [range of motion]),” authors write.

The outpatient track consisted of 2 to 3 physical therapy sessions per week for 4 to 6 weeks, plus a daily exercise program focused on range of motion, stretching, low-impact cardiovascular conditioning, and lower extremity strengthening and endurance. The HH program was harder to discern through medical records, authors write, but likely included physical therapy 3 times a week for 2 to 3 weeks, “with the ultimate goal of tolerance for outpatient [physical therapy] to complete rehabilitation.”

In the end, authors write, the decision as to whether to pursue immediate outpatient physical therapy or a period of home health physical therapy may depend on individual patient circumstances; still, they assert, “the results of this study provide evidence to the importance of patient education and shared decision-making between patients and the multidisciplinary team.”

“If the patient and the clinician determine that home health is necessary, then no loss of functional gains should be expected,” authors write. “However, it may take a longer time period, and perhaps expense, to achieve those gains.”

Dry Needling

Dry needling is a technique used to treat myofascial pain. The technique uses a “dry” needle, one without medication or injection, inserted through the skin into areas of the muscle, known as trigger points. Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles, and supported by research. Physical therapists use dry needling with the goal of releasing or inactivating trigger points to relieve pain or improve range of motion. Preliminary research supports that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles.
Andy Alaimo, DPT, is certified in Trigger Point Dry Needling. Several patients have already benefited from dry needling in combination with other physical therapy interventions.

Certified Orthopedic Manual Therapists

Congratulations to Amy Howard, DPT and Russ Simmerman, DPT for becoming certified orthopedic manual therapists (OMT-C). Both passed a comprehensive written exam and practical that was the culmination of several months of coursework, lab simulation and study. This certification guarantees knowledge and the ability to perform evidence based mobilizations and manipulations of the cervical spine, thoracic spine, lumbar spine, shoulder, elbow, wrist, hip, knee, foot and ankle. Our patients should take comfort in the fact our staff betters themselves through continuing education and advanced certifications. Nice job Amy and Russ!

New Study Suggests Perturbation-Based Balance Training Prevents Falls

A research report in the May 2015 issue of Physical Therapy concludes perturbation-based balance training reduces fall risk among older adults and individuals with Parkinson disease.

Many factors contribute to increased risk for falls. A specific fall event ultimately occurs when an individual fails to recover from a loss of balance or postural perturbation. Postural perturbations can occur in daily life for a variety of reasons, including failure to control weight shifting during voluntary movement or experiencing a slip or trip while walking. Balance recovery reactions, such as swaying around the ankles or hips, taking a step or taking a handhold are executed rapidly to prevent a fall following postural perturbations. Individuals with impaired balance control and increased fall risk often show difficulty controlling these balance recovery reactions. Because all ambulatory individuals are at risk for experiencing a loss of balance during daily life, training to improve control of balance recovery reactions may be an effective means of preventing falls. Perturbation-based balance training incorporates exposure to repeated postural perturbatios to evoke rapid balance reactions, enabling the individual to improve control of these reactions with practice.

Celebrating Occupational Therapy

April is National Occupational Therapy Month! We want to give a special shout out to our occupational therapist and hand guru Jane Burchfield. Jane is the most experienced certified hand therapist in the area. We appreciate Jane for her attention to detail, professionalism and willingness to serve her patients. Assisting Jane is COTA extraordinaire, Mishelle Dixon. Together, they make a great team. The proof is in patient outcomes.

Protect Your Back From an Early Age

School just started back. Did you know a child’s book bag should not weigh more than 10% of his or her bodyweight? Read more about this and other PT news via WebPT.

Conservative Treatment of Meniscus Tears

This article along with other recent studies suggests that for the large majority of folks with knee pain secondary to meniscus tear, there is not a significant improvement with arthroscopic repair versus conservative treatment, most notably physical therapy. Take a second to read.

  • I walked in feeling dizzy, miserable and nauseated from an episode of vertigo. Amy was able to provide treatment on the first visit that remedied my symptoms. I truly appreciate her expertise. She even called a few days later to check up on me. This is not something I had experienced from other health care providers. Thanks Amy!

  • Mike genuinely cared about my improvement. He was flexible and did not rush me. He always answered my questions to my satisfaction and provided teaching to enable me to do home therapy.

  • I couldn’t have been treated any better. The staff was so warm and caring! Thank you for all your help!

  • I have seen Alan for several ailments over the years. He has treated me for shoulder and back pain as well as rehab following my knee replacement. I had no idea what rehab entailed following knee replacement. He pushed me just the right amount but also respected my pain and concerns. Thankfully, I am back gardening and playing with my grandkids. I appreciate his knowledge and his willingness to take the time necessary to explain the source of my pain and lay out a vision how PT will help.

  • Jane was excellent. I had a long recovery following surgery on my hand after it was cut while at work. I found her to be knowledgeable, reassuring, patient and thorough throughout my course of therapy. She customized a splint for me and provided several other gadgets that initially improved the ease of daily activities but ultimately helped me return to work. I am forever grateful.

  • I have been to several physical therapy clinics. If I need to return I will not go anywhere else. I can function with minimal pain and I have found my home program to be a great benefit. I am thrilled with my improvements. I have resumed walking the loop several days a week without hip pain. This is something I truly enjoy and prior to intervention, I had my doubts. Many thanks.

  • Outstanding care provided. Superior professionalism. Extremely professional staff.

  • I had been told my only option was back surgery but thankfully I found Physical Therapy Services. They taught me how my posture was resulting in pain down my leg. I could tell a difference after only a few visits. I highly recommend them!

  • I am back surfing and paddle boarding without pain.

  • Thanks for your help. I am running without pain and looking forward to my first half marathon next month.

  • I am pleased with the care given to me at Physical Therapy Services of Wilmington. The staff is excellent as well as courteous and friendly. I never had to wait longer than 10 minutes for my appointment. It feels great to be able to walk without that pain in my foot!

  • I want to thank all the staff or a great experience. I started care in a great deal of pain. Everyone was very kind, professional and accommodating. Marie is a superstar! She literally changed my life. You guys have a fantastic staff. Keep up the good work. Thanks again.

  • I have improved tremendously from my initial visit and I am able to return to a normal active routine. I felt much better after each session.

  • Russ did an excellent job directing my rehab following rotator cuff repair. My ROM and strength feel better than it has in years. I am back playing tennis without restriction.